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Customer Email Address
Sales Rep Name
Customer First/Last Name
Customer Address
City
State
Zipcode
Insurance Provider
Claim Number
Date of Loss
Type of Loss
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Adjustor
Client
Does the house have ridge vents?
Yes
No
How many box vents
How many pipe boots
How many skylights
How many chimneys
drip edge
Yes
No
Ice and Water
Yes
No
Satellite
Yes
No
Email Address
Current Shingle Type
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LOCATION
5 Star Roofing & Restoration
3714 Alliance Drive
Suite 303
Greensboro, NC 27407
(336) 780-7800
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